The clinical picture of depression in preschool children

Joan L. Luby, Amy K. Heffelfinger, Christine Mrakotsky, Kathy M. Brown, Martha J. Hessler, Jeffrey M. Wallis, Edward L. Spitznagel

Research output: Contribution to journalArticlepeer-review

158 Scopus citations


Objective: To investigate the clinical characteristics of depression in preschool children. Method: One hundred seventy-four subjects between the ages of 3.0 and 5.6 years were ascertained from community and clinical sites for a comprehensive assessment that included an age-appropriate psychiatric interview for parents. Modifications were made to the assessment of DSM-IV major depressive disorder (MDD) criteria so that age-appropriate manifestations of symptom states could be captured. Typical and "masked" symptoms of depression were investigated in three groups: depressed (who met all DSM-IV MDD criteria except duration criterion), those with nonaffective psychiatric disorders (who met criteria for attention-deftcit/hyperactivity disorder and/or oppositional defiant disorder), and those who did not meet criteria for any psychiatric disorder. Results: Depressed preschool children displayed "typical" symptoms and vegetative signs of depression more frequently than other nonaffective or "masked" symptoms. Anhedonia appeared to be a specific symptom and sadness/irritability appeared to be a sensitive symptom of preschool MDD. Conclusions: Clinicians should be alert to age-appropriate manifestations of typical DSM-IV MDD symptoms and vegetative signs when assessing preschool children for depression. "Masked" symptoms of depression occur in preschool children but do not predominate the clinical picture. Future studies specifically designed to investigate the specificity and sensitivity of the symptoms of preschool depression are now warranted.

Original languageEnglish
Pages (from-to)340-348
Number of pages9
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number3
StatePublished - Mar 2003


  • Depression
  • Developmental
  • Nosology
  • Preschool


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